Effect of Losing Hospital-Based Obstetric Services on Maternal Health in Rural Communities

失去医院产科服务对农村社区孕产妇健康的影响

基本信息

批准号：
10450398
负责人：
Chun-Yu Ho
金额：
$ 15.14万
依托单位：
STATE UNIVERSITY OF NEW YORK AT ALBANY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-19 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10450398
关键词：
Adult Affect Affordable Care Act Area Birth Birth Certificates Black Populations Caring Characteristics Childbirth County Discipline of obstetrics Education Ethnic Origin Ethnic group Face Goals Health Health Professional Healthcare Hospital Closures Hospitals Improve Access Infant Health Insurance Low income Maternal Health Maternal Mortality Measures Medicaid Mothers National Institute of Child Health and Human Development Not Hispanic or Latino Outcome Outcome Measure Perinatal Care Play Policies Population Poverty Pregnancy Pregnancy Outcome Public Policy Records Research Risk Role Rural Rural Community Rural Hospitals Services Strategic Planning Testing Time Travel Uncompensated Care Urban Community Variant Vision Vital Statistics Woman adverse maternal outcomes adverse outcome aged base black women comorbidity falls gaps in access health of the mother improved maternal morbidity maternal outcome obstetric care opioid misuse prevent racial and ethnic racial disparity recruit reproductive rural area rural counties rural disparities severe maternal morbidity trend

项目摘要

Project Summary / Abstract There are striking urban/rural disparities in access to hospital-based obstetric care in the US, and the gap in access between urban and rural communities is growing. Access to hospital-based obstetric care is critical to health outcomes before, during, and after pregnancy. Rates of severe maternal morbidity and maternal mortality are rising in the US, particularly for mothers living in rural communities. We know little about whether lack of access to hospital-based obstetric care may play a role in adverse maternal outcomes in rural areas. This study has two goals. First, we estimate the effect of losing access to hospital-based obstetric care in rural U.S. counties on maternal health outcomes measured at the time of delivery, and test for disparities by race/ethnicity and by maternal education, using Vital Statistics birth certificate records from 2005-2018. Second, we estimate the magnitudes of policy- relevant factors affecting rural mothers’ health outcomes directly as well as indirectly through loss of access to obstetric care; these policy-relevant factors include the state’s ACA Medicaid expansion status, hospital characteristics, and local market characteristics. These findings are intended to provide new information on the health consequences of rural hospital and obstetric unit closures, and how public policies can be used to offset some of the impact.

项目摘要 /摘要在美国获得基于医院的产科护理方面，有惊人的城市/农村分布以及城市社区与农村社区之间的访问差距正在增加。进入基于医院的产科护理对怀孕之前，期间和之后的健康结果至关重要。严重母亲的速度美国的发病率和孕产妇死亡率正在上升，特别是对于居住在农村社区的母亲而言。我们对是否缺乏基于医院的产科护理可能会在广告中发挥作用，对此一无所知在粗糙地区的孕产妇结局。这项研究有两个目标。首先，我们估计失去的影响在美国农村县获得基于医院的产科护理，以测量孕产妇健康结果在交付时，使用重要的 2005 - 2018年的统计出生证明记录。其次，我们估计政策的幅度 - 直接影响农村母亲健康成果的相关因素直接以及间接影响获得产科护理；这些与政策相关的因素包括该州的ACA医疗补助扩展状态，医院特征和当地市场特征。这些发现旨在提供有关农村医院和产科单位关闭的健康后果的新信息，以及如何公共政策可用于抵消一些影响。